As a nurse I have a participant observer’s point of view to offer in contrast to those of many who have analyzed the recent Supreme Court ruling upholding President Obama’s Affordable Care Act. I’m not going to offer one more opinion about the morality or legality of the individual mandate or how the insurance companies and health care providers will have to adapt to the changes and how it can be repealed.

The proverbial elephant in the room (and perhaps the ACA’s fatal flaw) from my in-the-trenches standpoint is the sustainability question, How on earth is this health care system going to survive? The question has two components: First, the billions of dollars required to implement and sustain the ACA. Second, and most important, I’m talking about the viability of a system that is inextricably dependent on a ready supply of resources that are being consumed faster than they can be replaced. This rarely addressed issue was raised three years ago in the context of how sustainability was totally absent from the debate about the drafting and passage of ACA.[i]

Despite my awareness of the problem, when I am at work as a staff nurse, I unwittingly contribute to it. I necessarily consume a steady stream of disposable single-use products during the course of caring for my patients – pre-filled plastic saline syringes, plastic and paper medication wrappings, plastic IV fluid and blood product bags and tubing and their plastic wrappings, plastic lumen caps, plastic isolation gowns, plastic cups and straws, plastic juice containers (and there are excellent evidence-based reasons for all of it). I run around to my patients’ rooms with a “Jetson” – essentially a computer cart that is on 24 hours a day, 7 days a week – to scan wristbands and medication bar codes prior to giving medications. Then I sit down at desktop computers (also on 24/7) to document my assessments, page physicians and mid-level providers as needed, and write progress notes on my patients. I try to use alternatives as much as possible, for example, often there are cloth isolation gowns in the isolation carts that I use. And the non-profit hospital I work for has chosen to purchase cups with post-consumer recycled content, to virtually eliminate styrofoam, and to divert dozens of tons of waste through their recycling program. Nevertheless, I can’t help but wonder, even in the midst of my frenzied compulsory consumption, how this will all continue as we progress further along the downslope of Hubbert’s Curve.

There is plenty of evidence that we have, in fact, reached and surpassed the peak of global oil production, despite insignificant variations from year to year and the fact that we can still rely on fossil fuel resources whose production has yet to peak (e.g., coal). But no matter what your position on peak oil, it’s hard to argue with the fact that oil and other fossil fuels are resources that we are consuming faster than they can be replenished. And knowing first-hand about how the healthcare system operates, it’s also hard to ignore that modern medicine is almost literally dripping with them, given the amount of oil-based plastic products that pervade it, the amount of oil required for the production and transport of pharmaceuticals, and the predominantly coal or nuclear electricity required to run our health care facilities and power our electronic medical records.

Although I welcome any and all information to the contrary, I would rather spend less time rehashing the problems, since there is already a wealth of information about them[ii] and, instead focus on something we can all agree on – how to ensure the health and wellness of all people REGARDLESS of the availability of cheap fossil fuels.